| NPI | 1164798732 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: GA 89824) |
| Additional Taxonomies | 208600000X Surgery (Licence: NC 2019-01597) |
| 208600000X Surgery (Licence: PA MT201603) | |
| Enumeration Date | 2012-03-28 |
| Last Update Date | 2021-08-04 |